Wednesday, 4 April 2012

Physician Assistant program: A better alternative to MHA or MPH?

A better alternative to MHA or MPH?
This track may be better suited for international medical graduates who do not succeed in getting a residency but still want to pursue clinical medicine in the US. According to the Bureau of Labor Statistics (BLS) physician assistants (PAs) are formally trained to examine patients, diagnose illnesses, provide treatment and practice medicine under the direction of physician. They also have some interesting facts about physician assistants. According to them the median pay in 2010 was $86,410 per year and the job out-look in 10 years was projected to be 30% which is much faster than average.


The criteria for admission to a Masters program
These are not uniform all over the country but are for most part similar enough. There are 159 ARC-PA (Accreditation Review Commission on Education for Physician Assistant, Inc) accredited entry-level programs all over the US. The list of these programs is available at the ARC site. They all require some pre-requisite course work, which includes some combination of biology, microbiology, anatomy, physiology, biochemistry, and general chemistry, Statistics, psychology or even algebra. Non-medical subjects would be covered under the higher secondary certificate (HSC) while medical subjects like micro, biochem are covered in first year of medical school. Thus, application with a transcript that states the said subjects will strengthen the chances for a medical graduate to be accepted. Some PA programs like the one at Stanford School of medicine even require 3000 hours of direct patient contact before application. A year of internship, which most IMGs complete, may satisfy this criterion also. Also not all schools may allow non US citizens to apply but a preliminary research shows that there is no restriction to foreign applicants to these schools. The final decision is fairly school specific so it may ultimately depend on the admissions committee.

Enrollment to a PA program
Most of the programs also necessitate passing the GRE and/or TOEFL for admission to PA school while some colleges like Hofstra University in NY, Howard University in DC and Oregon Health Science University in Oregon do not require it. The complete list of GRE/TOEFL requirements for admission to PA programs is here. Even though each PA program has slightly different requirements and prerequisites for entry, the application is through Central Application Service for Physician Assistants (CASPA) for most programs. This application also needs to be completed by September 1st to meet the admission deadline.

Once enrolled in a PA program, the curriculum lasts for 2 years at the end of which you can appear for Physician Assistant National Certifying Exam (PANCE).  The first year is normally the ‘didactic phase’ while the second year is the ‘clinical phase’. Patient care experiences are encountered in a different clinical facilities (That’s your USCE right there). After passing PANCE applicants can use the PA-C designation.

So how does this method stack up for foreign medical graduates?
For those who are considering Masters track as either a temporizing measure or to enhance your resume, a Masters in PA offer following advantages

  • Legitimate reason to stay in US while pursuing degree education
  • Building network and connections while obtaining your degree.
  • Get US letters of recommendation (LOR)  from faculty during training
  • US clinical experience is built into the PA training system
  • Excellent opportunity to re-enter clinical practice for those with multiple attempts, horrendous scores and those who otherwise have no chance of securing residency.
  • Excellent job prospects after completion of training with a decent pay scale.
  • Shorter duration than Nursing degree (4 years) or doctoral degree (PhD) as an alternative.
  • If you chose to apply for residency, you may enhance your resume, obtain contacts and generally improve your chances or if you chose to forgo residency, you still can work in patient care areas.

Disadvantages

  • Though no job is less than other, some physicians may harbor a bruised ego from being a physician to a physician assistant.
  • Does involve paying tuition and fees, which can be substantial. However, considering you would pay tuition and fees for other masters programs as it is, the point is moot.

Thus in conclusion, there may be a subset of international medical graduates who can benefit tremendously for considering this as an option.

42 comments:

  1. but they require GPA more than 3.0

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    1. Yes. Excellent point. GPA requirements are indeed present. Some programs will allow translation and verification of courses from foreign schools by independent agencies like World education services or the knowledge company.

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  2. Hi Droider!
    I am applying to Masters in Public Health prog for this coming spring. Could you please provide me with a sample LOR? I need 3 of them to complete my application.

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    1. Hello Dr. Rao, There are several excellent sources online for LOR templates especially for admission to graduate school. Good luck!

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  3. Hello,
    This is very informative, and I am really grateful to you for this post.
    I am an IMG from india and applied for 2013 match, haven't got any IVs yet.
    I am a 2008 graduate, on h4 visa, completed all the steps including step 3.
    As I haven't got any IVs yet, I started searching for alternative paths for FMGs in US, and came across your post. I am very interested in PA programs but not sure does the programs allows IMGs to enter in the program? if yes then How competitive is the admission process? My GPA is 3.4 and I am willing to take GRE or TOEFL.
    Many programs require completion of bachelor courses from accredited US colleges, which obviously I dont have. do you know any programs which allows IMGs to enter in the programs without this prerequisite?

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    1. hi i do not know directly if IMGs are eligible straight away for PA programs. you can look up on paeaonline.org or CASPA to tease out the details. There are anecdotal reports of folks getting into PA programs on forums but I do not have first hand information about it. Good luck!

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    2. You have to complete the prereqs to be able to be considered for application. the app process is very competitive. One accredited univ(ranked around 70-80) said that they receive 2000 appli and only 150 are called for interview and only 95-100 are admitted.
      From my experience IMGs especially with ECFMG cert, are not looked upon favorably, they feel that blending into the system for such individuals will be made difficult due to ego issues, hence given later preference.
      It does not help with match and hospitals consider it a negative impact since it reflect lack of 'focus'. I'm not saying this, it is how it is....

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    3. Thank you Dr. SA for that input.

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    4. I'd like to add to the above...
      I have a 3.95 GPA. Despite this program co-ordinators did not accept Anatomy, Physiology, Microbiology credits since they were taken in the initial years of med school, and by the time I applied to PA courses, it was no longer "valid" according to them. So before applying to PA course you have to take Undergrad level of these courses along with Sciences and English (roughly a year in UG or Comm college, if you are really motivated to apply) before you are even eligible to apply! So IMHO it's better to stick to MLE.

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  4. Why does ECFMG certified cannot just go ahead challenge the PANCE, but have to go to the hoola-hoop of 2 year program just for the purpose of making a loan of more than $60,000 for two years of waste ? IS it just for the purpose to feed the greed of those programs, and become another absurd, cruel, nonsense, REALLY BAD MANAGEMENT to steal money from those vulnerable US-citizen FMGs who have already proved their talents and competency via the hardest professional licensing examination, even much more DIFFICULT than the PANCE, the USMLE ??? that is obviously the GREED there! that is also how this country healthcare system has been crewed up because of those greedy and nonsense medical training system!

    the government, president should get involved to enact this into law that ECFMG holders can go ahead to challenge this PANCE.

    I am a US citizen ECFMG holder, and not like many people think, i have no problem working as a PA, no problem at all about my ego ! Working as a healthcare mid level professional which i can use my skills and extensive knowledge to serve the community would be my happiness.

    But, i would never go through a PA program of two years of waste both money and time.

    But life is cruel, unfair.......and what do you think who create these cruelty and unfairness ? VERY SADLY, IT IS THE PEOPLE WITH POWER FIRST OF ALL ! that is how they have power, and power usually goes with how they make money !

    I am very different, and i know some other FMGs who are now living in homeless shelter with the same idealogy......we are all belonged to community intelligence property and grey matter property......but we are treated too badly ! That is not our mistake to make those GREEDY PEOPLE becomes more greed and more cruel !

    Until the right people can change this, we are in the dark ! the dark of the brightest !

    Katherine M

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    1. Hello Dr. Katherine, you do bring up some excellent points. Thanks for providing a perspective different from any I have come across.

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    2. @Droidor: I am not the first person to bring this issue up that US citizen / Green Card holder - ECFMG certified are qualified to challenge the PANCE, this issues has been on debating for a while, and it is still a long and sweaty and even bitter struggle, but we do hope we will win the justice, because apparently justice belong to us ! It is nonsense to take the program PA with a big loan when we already pass the USMLEs which are much more difficult than the PANCE.

      there has been a petition to president Barack Obama to allow US citizen/GC ECFMG certificate holders to challenge the PANCE. There is a huge shortage of primary care provider in our US healthcare industry now and those PAs programs only think of luring us into BIG STUPID traps ! excuse me, we are educated, we know what is right and what is wrong !

      this is still an ongoing sweaty, hard, tedious struggle for our future !

      I ask everybody to take part in this fight for justice for US citzen/GC ECFMG holders ! there are many who are living in homeless shelters ! WHAT A SHAME HOW SOCIETY TREAT INTELLIGENCE PROPERTY !

      we need to bring lights into our darkness !

      WE ARE NOW IN THE DARK, THE DARK OF THE BRIGHTEST !

      we need to caught attention of the president for help ! THIS IS REALLY A BIG DEAL !

      americans no need more student loans, which is already in trillions of dollars !

      Katherine M

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  5. This is not only a problem for FMG's. Consider that there are also DMG's(domestic medical graduates) who for myriad reasons have deferred, interrupted, or quit residency training and/or medical practice. Re-entry to residency or practice presents formidable obstacles, including in some instances retaking formerly passed USMLE exams. There is a very large disconnect between the requirements to practice as a physician and a physician assistant in the U.S.. Consider the discrepancy in education/training (2 years post-bach verses a minimum of 7 years) and in many cases the need for "board certification", requiring additional time, tests, expense after residency training. Why not make being a PA an option for all medical graduates, an alternative to completing residency which would serve to make employable those physicians who haven't completed a residency (but obviously have at least the equivalent education of a PA) and ALSO address the massive shortage of healthcare professionals both present and projected. Sharin P

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    1. very practical consideration given there are many medical school graduates who are unable to get into residency for whatever reason. Thanks for sharing your thoughts.

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  6. reading all the above,,,
    I feel intimated to start my USMLE exams , I am IMG since 5 years, and will need another 2.5 - 3 years to prepare and pass the USMLE exams.
    please I need straight forward advice if should I start or not. it is a great wast of time and money if after passing all the exams I won't be able to enter the residency program.
    thank you and all the best for every one.
    Dr.Ezzat

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    1. 8 years after graduation puts you in a old graduate category. there are certain hardships this batch of applicants face. however the application to USMLE can still be considered if there has been no gap in medical training/practice. consider the pros and cons of pursing residency training in US. You may want to decide if you want to go ahead or not based on your scores.

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  7. hello sir,,,
    i am a IMG who graduated in 2011 march ,,,planning to give mle step 1 in feb or march...will it be too late if i complete all my step 1 and atep 2 ck by jjuly august and and give cs and and 3rd step in 2015 march apply in sep for the match(2016match)???? in the mean time other than mhc(not that useful) or masters or phd(as its too long) wht do you suggest me to do while ma in the USA for cs and step 3 exams(2014sep -2016march , as match completes by then)???
    PA sound very exciting but can it dne wit scholarship and enrolled in jan session or is it a waste of money and time as one them said??? am confused and hope somebdy replies

    thank you so much

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    1. IF you are planning for March 2016, then you profile needs to be complete by September 2015. Thus you have between decent time to be ready for the match provided you complete the steps in the next year and a half. So you should be done with all steps by March 2015 leaving you the last few months to decide the course of action based on your scores - USCE contacts LORS etc. It depends on what your length of stay is in US, if it is short - few months on end, then I highly recommend just doing observership, shadowing or volunteering. If you are going to be in US for next 2 years, then masters may be an option. PA school can be expensive and may not be a positive experience for physicians. So firstly, you goal is to finish your exams in given time frame, ensure that you score well, plan of doing some things on the side to keep yourself clinically busy - studying for exams is not a good thing to put on your CV - will be considered as gap. So do something that is clinically relevant. Good luck!

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  8. anyone having idea about p.a. program that allow imgs. m having green card holder,and having a doctorate degree from russia.and i deside to join p.a.program.my g.p.a. is around 3.8 and m planning to give both g.r.e and toefl. any 1 having idea about any college that accept me. please suggest me some of those university from which i have a good chance of getting interviews.suggest me also those colleges which don't require any g.r.e and toefl. cause m having sort of time.thank you friends. i really appreciate ur help.best luck to all.

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    1. Dr. Patel, the best recourse would be for you to check out the American academy of physician assistant site. You will find the prerequisites for admission to PA schools and list of accredited PA programs. Good luck!

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    2. I am also an IMG 2007 grad. I am US citizen, usmle 211,203,211 cs passed. this is 3rd time i have applied for Match. 1st yr 7 ivs = no match, 2nd yr 3 ivs= no match , this yr 2 ivs and hoping for best. I attended information meetings at eastern michigan univ, wayne state university and univ of Toledo for PA program. All 3 give zero credit for being a physician or ECFMG certified. Since i took anatomy, physio, biochem in 1st yr medical school so they exceed 8yr limit and i have to take all pre reqs which I am taking, infact had to take algebra this semister. For all IMGs you have to have Anatomy, physiology, chemistry, stats, psychology, microbiology within last 8 yrs. if they were taken before 8 yrs you have to re take them from any community college . Only than you are eligible to apply for PA. Also wayne state requires avg 3000 hrs of direct patient care and that shud be in last 2 yrs before you apply to the program. Can not be older than 2 yrs. Univ of Toledo do not require GRE but other 2 do. I am into 2nd semister for my pre reqs now.I hope that helped some of you. and yes all PA program need GPA minimum to be 3. means the higher above 3 the better it is.

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    3. Thank you Dr. Hashmi for the excellent and insightful piece of information and sharing your personal experience.

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  9. Can anyone kindly give me information about medical sonography course?

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    1. from https://www.sdms.org/career/career.asp

      Comprehensive Diagnostic Medical Sonography programs vary in length from one to four years depending on the degree or certificate awarded. Prerequisites also vary among programs from high school diploma or GED to specific qualifications in a related allied health profession.

      The SDMS recommends that prospective students select a reputable program that follows minimum curriculum and clinical education standards recognized by the American Registry for Diagnostic Medical Sonography (ARDMS.) The SDMS does not recommend training programs that provide limited opportunity for students to apply classroom instruction and technical skills in patient care settings (clinical rotations). When seeking a reputable program, candidates might wish to consult the Commission on Accreditation of Allied Health Education Programs (CAAHEP) which accredits diagnostic medical sonography programs in the United States. A list of accredited programs is available on CAAHEP's web site, www.caahep.org.

      According to Bureau of Labor statistics: Median pay for this job was $60,350 per year or $29.02 per hour
      http://www.bls.gov/ooh/healthcare/diagnostic-medical-sonographers.htm

      Are you a physician? What is your motivation to look into this as an option?

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    2. I'm a physician and working as a sonologist in my country. Now,I'm in USA and trying for USMLE. Things are getting harder and looking out for a alternative career

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  10. Hi everyone this blog has cleared alot of confusion in my mind. Im a fmg and have applied for my citizenship. Im a 2009 graduate. Im going to start taking community college classes for algebra, english and chemistry this summer. Do you think it is wise for me to apply to caspa this year or should I wait for next year, I mean will they consider me since I dnt hve any gre, mcat on hand and I just joined to complete the prerequisites

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    1. Hi Dr. Arifa, please check with individual schools that you are interested in applying for prerequistes. "Each PA program has different deadline requirements and prerequisites for entry. Please contact the schools to which you are applying to determine their entry requirements. In addition, each PA program has its own start date; to determine exactly when a school’s program will begin and to ensure you are filling out the correct application, please contact the school directly.: -
      https://portal.caspaonline.org/caspaHelpPages/about-caspaoverview/

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  11. Hi thanks a lot, I have one more problem, most of the pa programs require anatomy, physio and biochem to be completed at a regional institute not accepting tge courses we took in med school. Are there any program s that accept foreign courses

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    1. Hi! Thanks for writing. I have compiled answer to your question with few other questions here http://www.mleresidencytips.com/2014/05/question-and-answer-session-1.html (Q3)

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  12. This comment has been removed by a blog administrator.

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  13. can i give MCAT and study Medicine in USA again? Thanks

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  14. I am an old graduate.
    Step 1 ; 206 ( 2nd attempt)
    Step 2CK; 200 ( 1st attempt)
    Step 2CS: failed 3 times ( sitting for 4th time)
    Do i have any chance of getting residency?
    I want to give MCAT and want to study Medicine in USA.
    What is your advice? Thanks

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  15. Hi! Thank you very much for the useful information. my situation is a bit complicated and hoping you can help me. I was studying medicine in the middle east and transferred my credits to a carribean university. They gave me 2 options: 1) sign a waiver form stating that I will not ask for any support from the college for ecfmg certification and will not work as a physician as a graduate from the carribean university. Which means I can do the pending clinical rotations and obtain a MD degree with just WHO recognised and not ecfmg certified. 2nd option is to go thru the typical way of writing usmles and applying for residency once I finish the usmles. Now I've spent a year preparing for the usmles and nbme's but have not reached anywhere and im on my own funding. I need to get some pay and work somewhere or do a masters or phd and side by side writ the usmle because I don't want to sign the form incase it prevents me to apply for usmle later and dont want to give up on applying for residency. please advice me if I can apply for usmles and residency later once I graduate even though I sign the form now? or what other alternate can I do since I have a bachelors in health science and I will get a MD degree with WHO accreditation once I sign the waiver form. Please advice. Thank you

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  16. Hi,

    Thanks for the amazing website! It's really informative and helpful.

    I was wondering about the MD/PhD Programs offered. International graduates may apply; however, what about those from South Asia: where we are given MBBS. Would that count as a bachelor's degree?

    I have searched a lot of places for this information but it seems to be 'confusing'.

    Thanks,

    Tariq

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  17. What is staggering is that the dearth of physicians in the US is not temporized by the plethora of determined, willing, and able-minded foreign medical graduates. Astonishing...Politics is just not fair...

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  18. HELLO ALL!! This is one of the best posts. I , an IMG, graduated from med school in 2012 November. I completed ecfmg certification in 2014 but didn't get matched in march 2015. I have been looking for alternatives since then. - PA[ which has subject credits problems], Anesthesiology assistants, MPH, MHA, microbiology, even clinical lab assistants.. are there any alternatives for IMG.. ANY.ALLIED.MEDICAL.FIELD, which has job prospects later [and decent salary... in all these programs, no company wants to sponser work visa for non us citizens.. that's what i heard.. does someone know otherwise??. PA is good, but then I cant go to college to do those 2 or 3 subjects.. Has someone finally solved this mystery?

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    1. hey vivek! hope all is well. i just read your post and would like to know if you found which option is the best for IMGs out there. As i can see, you posted this about 10 months ago and I am currently in the same situation as you were in. I would like to know the best concluded alternative route for an IMG. I didnt attempt the USMLEs and dont plan on doing it. SO please do help and advise the best of your knowledge. thanks a million.

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  19. This comment has been removed by the author.

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  20. if anyone needs to know more about getting into pa u can email to p_uss1982@yahoo.com

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